Pediatric Diet Compendium Nutrition & Food Services Winnipeg, Manitoba

WRHA Pediatric Diet Compendium 2008

Table of Contents

Acknowledgements Introduction When to Consult a Dietitian HSC Hospital-Wide Nutrition Screening Program How to Order a Pediatric Diet Key Nutrients in Eating Well with Canada’s Food Guide

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Pediatric Standard Pediatric Standard 0 - 6 months Pediatric Standard 7 - 12 months Pediatric Standard 12 - 24 months Pediatric Standard 2 - 5 years Pediatric Standard 6 - 17 years

1-1 1-1 1-1 1-1 1-2 1-2

Fluids No Fluids on Tray Clear Fluid

2-1 2-1 2-1

Energy/Carbohydrate Modifications Controlled Carbohydrate Controlled Carbohydrate / HS Snack High Energy

3-1 3-1 3-1 3-1

Mineral Modifications ≤ 130 mmol Sodium < 90 mmol Sodium Low Potassium High Potassium Controlled Phosphorous Low Copper

4-1 4-1 4-1 4-1 4-1 4-1 4-1

Fat Modifications Modified Fat

5-1 5-1

Fibre Modifications Controlled Fibre Fibre Enriched

6-1 6-1 6-1

Feeding and Swallowing Management Texture Modifications Soft Soft / Minced Minced Total Minced Pureed Blenderized

7-1

WRHA Pediatric Diet Compendium 2008

7-1 7-1 7-1 7-1 7-1 7-2

Feeding and Swallowing Management Viscosity Modifications Thick Fluid – Nectar Thick Fluid – Honey No Fluids Combined with Solids

7-3 7-3 7-3 7-3

Food Allergies Allergy – Egg Allergy – Fish and Shellfish Allergy – Milk Protein Allergy – Peanut Allergy – Tree Nuts Allergy – Sesame/Mustard Seed Allergy – Wheat Limited Standard

8-1 8-1 8-1 8-1 8-1 8-2 8-2 8-2 8-2

Food Sensitivities Gluten Free Low Lactose Low Sodium Benzoate Low Sulphite

9-1 9-1 9-1 9-1 9-1

Metabolic Disorders Controlled Protein (< 20 grams) Controlled Fat Fructose, Sucrose, Sorbitol Restricted Low Long Chain Triglycerides

10-1 10-1 10-1 10-1 10-1

Diet and Food Preferences Kosher Style Kosher No Beef No Bell Peppers No Chocolate No Citrus

11-1 11-1 11-1 11-1 11-1 11-1 11-2

(Orange, Lemon, Lime, Grapefruit)

No Mushroom No Onion No Pork No Poultry No Strawberry and Raspberry No Tomato Vegan Lacto-Vegetarian Ovo-Vegetarian Lacto-Ovo-Vegetarian Pesco-Vegetarian Pollo-Vegetarian

11-2 11-2 11-2 11-2 11-2 11-2 11-3 11-3 11-3 11-3 11-3 11-4

Table of Contents (Con’t)

Test Diets Caffeine Free

12-1 12-1

Other Diets Low Iodine Low Oxalate Low Tyramine Ketogenic Diet NPO or TPN or Tube Feeding TPN or Tube Feeding with Tray

13-1 13-1 13-1 13-1 13-1 13-2 13-2

WRHA Pediatric Diet Compendium 2008

Acknowledgements The Winnipeg Regional Health Authority would like to acknowledge the following clinical dietitians for their hard work, professional contribution and unfailing dedication in the development and revision of this Diet Compendium: Brenda Hotson, RD, MSc, Chair Julie Gislason, RD Dianne Cardinal, RD Lisa Wilson, RD Valerie Howden, RD, MSc Pat Ozechowsky, RD, CNSD Monica Roberts, Dietetic Technician Dayna Weiten, RD Thank you also to the following physicians, dietitians and nurses from facilities across the region/nation who reviewed the Diet Compendium and provided valuable suggestions: Dr. Cheryl Greenberg Dr. Malcolm Ogborn Dr. Gina Rempel Dr. Kristen Pederson Dr. Tom Blydt-Hansen Phyllis Malowski, RN Lynne Lepage, RD Dallas Baumler, RD Maggie Chapman, RD, IWK Health Centre, Halifax, NS Julie Nedvidek, RD, Hotel Dieu Hospital, Kingston, ON Sally Gilbert, RD, BC Children’s Hospital, Vancouver, BC

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Introduction The WRHA Nutrition & Food Services Pediatric Diet Compendium contains a list of the diets and their definitions available in the system. All diets and combinations of diets must be ordered from the WRHA Nutrition & Food Services Pediatric Diet Compendium. The WRHA Nutrition & Food Services Pediatric Diet Compendium integrates the most current research in medical nutrition therapy in order to achieve evidence-based best practice. Those diets that are consistent with adult diets are adopted from the WRHA Adult Diet Compendium. Both the Adult and Pediatric Diet Compendiums have been approved by the WRHA Nutrition Advisory Subcommittee of the WRHA Regional Pharmacotherapy Committee. Diet definitions are based on a non-selective diet.

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When to Consult a Dietitian • • • •

Patient is at nutritional risk and requires assessment Patient requires assessment prior to enteral or parenteral feeding Patient requires nutrition education Clarification of diet order is needed

Health Sciences Centre Hospital-Wide Nutrition Screening Program A comprehensive nutrition screening program exists at HSC to identify malnourished patients or patients who are at risk of becoming malnourished and who are likely to benefit from specialized nutritional care during their hospitalization. All patients are screened within 48 hours of admission and those who fall within the moderate to high nutritional risk category are seen by the clinical dietitian.

How to Order a Pediatric Diet The following guidelines provide a baseline for diet ordering. Consult the clinical dietitian to determine the most appropriate diet modifications and/or restrictions; this will ensure that the patient receives optimal medical nutrition therapy. Diet Ordering Guidelines: Pediatric Standard, 0-6 months: Pediatric Standard, 7-12 months: Pediatric Standard, 12-24 months: Pediatric Standard, 2-5 years: Pediatric Standard, 6-17 years:

Specify type of formula Specify texture, specify type of formula if applicable Specify texture if required Specify texture if required Order “entrée large” for children ages 13-17 in order to meet Eating Well with Canada’s Food Guide recommendations for this age group.

All therapeutic diets (renal, metabolic, texture, controlled carbohydrate, allergy) must be ordered with a pediatric standard, age-specific diet order from the WRHA Nutrition & Food Services Pediatric Diet Compendium. Examples: 1. Patient is a 4-month-old who is being exclusively breast-fed. Diet Order: Pediatric Standard, 0-6 months, specify breast-fed or type of formula 2. Patient is an 8-month-old who eats minced table foods at home. Diet Order: Pediatric Standard 7-12 months, Minced, specify breast-fed, type of formula or whole milk 3. Patient is a 2 year old with no nutritional issues. Diet Order: Pediatric Standard 2-5 years. Continued…

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4. Patient is a 10-year-old with no nutritional issues. Diet Order: Pediatric Standard 6-17 years 5. Patient is a 15-year-old with no nutritional issues. Diet Order: Pediatric Standard 6-17 years, entrée large 6. Patient is a 24-month-old with dysphagia. Diet Order: Pediatric Standard 12-24 months, Pureed, Thick Fluid Honey 7. Patient is a 3-year-old with allergies to walnuts. Diet Order: Pediatric Standard 2-5 years, Allergy - Tree Nuts 8. Patient is a 4-year-old with Type 1 diabetes. Diet Order: Pediatric Standard 2-5 years, Controlled Carbohydrate with Snack 9. Patient is a 12-year-old boy on peritoneal dialysis; sodium, fluid and phosphorus restricted at home (medications include phosphate binders). Diet Order: Pediatric Standard 6-17 years, 130 mmol Sodium, No Fluids on Tray, Controlled Phosphorus 10. Patient is an obese 15-year-old with Type 2 diabetes. Weight loss is desired. Diet Order: Pediatric Standard 6-17 years, Controlled Carbohydrate, Modified Fat, Small portions 11. Patient is a 4-year old with allergies to red food dyes and poultry. This is an example of an allergy NOT listed in the HSC Pediatric Diet Compendium. Diet Order: Pediatric Standard 2-5 years, Limited Standard and specify the allergens

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Key Nutrients in Eating Well with Canada’s Food Guide Enjoy a variety of foods from the four food groups. To accommodate different food preferences, each food group includes a wide variety of choices. Eating different foods within each group will help people get all the nutrients they need. The table below shows how each of the four food groups contributes a certain combination of nutrients to the healthy eating pattern.

SOME IMPORTANT NUTRIENTS IN THE FOOD GROUPS Key Nutrients Protein Fat Carbohydrate Fibre Thiamin Riboflavin Niacin Folate Vitamin B6 Vitamin B12 Vitamin C Vitamin A Vitamin D Calcium Iron Zinc Magnesium Potassium

Vegetables and Fruit

Grain Products

9 9

9 9 9 9 9 9

9 9

Milk and Alternatives 9 9 9

9

9 9 9

9 9

Meat and Alternatives 9 9

9 9 9 9 9

9 9 9 9 9 9 9

9 9 9

9 9 9 9

Eating Well with Canada’s Food Guide: A Resource for Educators and Communicators, Section 3: Make Each Food Guide Serving Count, Page 9.

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WRHA Pediatric Diet Compendium 2008

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Definition

Pediatric Standard • •

Pediatric Standard 0 - 6 months •

• •

• • • •

Pediatric Standard 7 - 12 months

• • • •

•

• •

Pediatric Standard 12 - 24 months

WRHA Pediatric Diet Compendium 2008

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< 800 Kcal Patient tray not provided. Nutrients are provided by breast milk and/or iron fortified breast milk substitute. Introduction of solid foods should occur at age 6 months for term infants Breast-fed term infants require Vitamin D supplementation of a minimum of 400 International Units daily Must be ordered with a specific texture modified diet (refer to 7-1), specify breast-fed or type of formula 700 - 1000 Kcal o 50% fat o 40% carbohydrate o 10% protein